1. Healthcare

Student’s Name: ______________________________________ DCFS/Probation Case #: ________________________
Upon completion, please return to your DCFS ILP Coordinator. Your Coordinator’s number _________________________
Celebration 2015 Application
Dear Graduating Senior,
Congratulations on your upcoming graduation! If you are planning to go to college in the summer/fall of 2015 and have a 2.8
GPA or higher, you are invited to participate in Celebration 2015 – an event held in honor of your academic
accomplishments – on Thursday, June 18, 2015, at the Walt Disney Concert Hall. In total, more than $800,000 in
scholarships will be awarded to students planning to attend college or vocational school.
Please fill out the following questions and submit with your essay to complete your registration:
A. I have applied to the following colleges or trade schools (we encourage you to have at least one 4-year college):
1) ______________________________, 2) ______________________________, 3) ________________________________.
B. If you applied early or plan to attend a 2-year school, please complete the following questions.
I have already been accepted to: ______________________, _________________________ , __________________________.
I plan to attend: ________________________________________ College/University/Trade School beginning ________ 2015.
C. I think my college / vocational major and/or minor will be ___________________________________________________.
D. I work/participate in extracurricular activities: ____________________________________________ hours per week ____
E. I have a personal computer/laptop/tablet (circle) yes no If so, what do you have? _______________________________
To participate in the event and be eligible for the accompanying scholarship, you must turn in a Celebration
Application, an essay and an unofficial transcript to your ILP Coordinator by Tuesday, March 25, 2015!
Before you submit your application, complete the following:.
Have you completed a 1 ½ page, double-spaced ESSAY on the following topic and provided your unofficial transcript? Yes No
Please describe any accomplishments and/or challenges you have experienced and explain your future personal and career goal
through college or trade school and beyond. Note: You should also attach a resume and letters of recommendation for the
scholarship selection process.
STUDENT AGREEMENT: By signing and submitting this form, I agree to attend the Celebration Orientation on
Saturday, April 25, 2015, from 9am to 3pm at Pasadena City Community College (Main Campus) and the Celebration 2015
event on Thursday, June 18, 2015, at the Walt Disney Concert Hall. You will receive further information about the
orientation by mail. Students who do not attend both the orientation and the event will not be eligible for scholarships.
Note: By signing this application I also understand and approve this application/essay be shared for scholarship consideration.
Name: ______________________________ Signature: ____________________________ Birth Date: _________ Age _____
Address: __________________________________________________________
City,
State
Zip Code
Gender: Male Female
Ethnicity ________________
Home # _________________________ Cell #: _________________________ Email: ________________________________ _
Caregiver Name: ______________________ Caregiver Signature: _________________________ Placement Type: ________
(Coordinator’s Use Only)
Social Worker Name: ________________________________ SW’s Phone/Cell #: ___________________________________
SCHOOL COUNSELOR SECTION (SCHOOL SEAL OR STAMP MANDATORY):
Is this student on track to graduate by June 2015? Yes No
If no, what is the student’s expected graduation date? _________
Did he/she pass the CAHSEE? Yes No If not what subject does he/she need to pass? _______________________________
Student’s cumulative GPA (please use overall GPA from 9th grade through fall Semester of 12th grade): _____________________
This student has ________________ credits towards graduation and is taking __________________ credits in the spring semester.
Name of High School: ___________________________________________________________________________________ __
Counselor’s Name (printed): __________________________ Phone: _________________ Email: ________________________
Counselor’s Signature: ________________________________________ Date: ______________________________________
DCFS Only
Transporter Name: _____________________________
Relationship: _________________
Contact #: (_____) _____-________
Celebration 2015 presented by the Los Angeles County Board of Supervisors, LA County Department of Children and Family Services/Probation Department
Youth Development Service, Rotary Club of Los Angeles and the United Friends of the Children (UFC)